Address for correspondence: Jarosław Meyer-Szary, MD, PhD, Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, ul. M. Skłodowskiej-Curie 3a, 80–210 Gdańsk, Poland, tel: +48 58 349 28 82, e-mail: jmeyerszary@gumed.edu.pl
Received: 26.04.2021 Accepted: 8.06.2021 Early publication date: 7.07.2021
This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
Outcomes associated with lidocaine and amiodarone administration in pediatric
in-hospital cardiac arrest
Jaroslaw Meyer-Szary
1, Aleksandra Gasecka
2, Ivo John
2, Milosz J. Jaguszewski
3, Frank W. Peacock
4, Natasza Gilis-Malinowska
3, Lukasz Szarpak
5, 61Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Poland
21st Chair and Department of Cardiology, Medical University of Warsaw, Poland
31st Department of Cardiology, Medical University of Gdansk, Poland
4Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, United States
5Maria Sklodowska-Curie Medical Academy in Warsaw, Poland
6Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
This paper was guest edited by Prof. Togay Evrin
Pediatric in-hospital cardiac arrest is a devas- tating condition with the average annual incidence of 15,200 cases in the United States [1]. The sur- vival rate after hospital discharge remains poor (~55%) [2], although it shows an increasing trend in the last decade [3]. In the pediatric population, around 10% of patients have initial shockable rhythms (ventricular fibrillation or pulseless ven- tricular tachycardia) following cardiac arrest, and 15% of patients develop them during resuscitation.
The rate of shockable rhythms varies depending on the patient age and is lowest for infants, followed by children and adolescents [4]. Early defibrillation and high-quality cardiopulmonary resuscitation are the core of treatment for cardiac arrests caused by shockable rhythms, followed by administration of adrenaline and antiarrhythmic drugs [5].
Amiodaron and lidocaine are used in the treat- ment of pediatric cardiac arrest with shockable rhythms refractory to defibrillation. Previously, amiodaron was recommended by the American Heart Association (AHA) Guidelines for Cardiopul- monary Resuscitation and Emergency Cardiovascu- lar Care 2010: Pediatric Advanced Life Support [6], and by the European Resuscitation Council (ERC) 2010: Pediatric Life Support Guidelines [7] as the
preferred antiarrhythmic. Currently, both AHA 2020 [8] and ERC 2021 Guidelines [5] state that amiodaron and lidocaine can be used interchange- ably, depending on the physician’s preferences.
However, data regarding the outcomes associated with amiodarone and lidocaine administration in pediatric cardiac arrest are very limited. Therefore, this study is a systematic review and meta-analysis to determine the efficacy of amiodarone and lido- caine in pediatric cardiac arrest.
This present review and meta-analysis were performed following the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. The search of data included the Embase, Medline and the Cochrane from the da- tabases’ inception to April 15, 2021. Studies included in this meta-analysis met the following PICOS crite- ria: (1) Participants: patients < 18 years of age with cardiac arrest due to any cause; (2) Intervention:
amiodarone treatment; (3) Comparison: treatment with lidocaine; (4) Outcomes: detailed information for survival; (5) Study design: randomized controlled trials, observational trials comparing lidocaine and amiodarone in pediatric resuscitation. Studies were excluded if they were reviews, guidelines or articles not containing original data.
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clinicAl cARDiOlOGY
Cardiology Journal 2021, Vol. 28, No. 5, 783–785
DOI: 10.5603/CJ.a2021.0077 Copyright © 2021 Via Medica
ISSN 1897–5593 eISSN 1898–018X
ReseaRch LetteR
Following identification and selection of the relevant studies for the present meta-analysis and removal of duplicates and nonrelevant trials, two studies were included in the analysis [9, 10].
Both studies focused on in-hospital cardiac arrest (IHCA).
Results of the pooled analysis of IHCA out- comes is presented in Table 1. In the full cohort, the use of lidocaine in pediatric resuscitation was associated with a higher incidence of return of spontaneous circulation (71.4% vs. 59.1%, re- spectively; odds ratio [OR] 1.96; 95% confidence interval [CI] 1.39–2.77; p < 0.001), survival to 24 h (54.0% vs. 39.7%; OR 1.94; 95% CI 1.39–2.69;
p < 0.001) and survival to hospital discharge (32.2% vs. 23.4%; OR 1.68; 95% CI 1.16–2.44;
p = 0.006), compared to amiodaron. There were no differences regarding favorable neurological outcome at hospital discharge in patients who re- ceived lidocaine and amiodarone (21.0% vs. 21.3%, respectively; OR 0.98; 95% CI 0.57–1.68; p =
= 0.95). In the propensity-score matched cohort data (comparison of propensity-matched patients from the first study [9] and all patients from the sec- ond study [10], no significant differences between
the use of lidocaine and amiodarone were found in terms of all researched outcomes.
In conclusion, despite better IHCA out- comes associated with lidocaine in the full cohort analysis, analysis of the propensity-matched data showed no significant differences between the treatment arms. Although the small number of studies included in this meta-analysis and lack of access to individual patient data is a limitation, the meta-analysis herein, implies that results of previous studies comparing lidocaine and amiodarone in pediatric cardiac arrest should be interpreted which caution, as the observed differ- ences might be due to substantial differences in patient baseline and clinical characteristics. Fur- ther randomized controlled trials are warranted to establish which treatment strategy is associated with better outcomes.
Conflict of interest: None declared References
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Table 1. Pooled analysis of pediatric cardiac arrest outcomes in patients treated with lidocaine and amiodarone.
Adverse event
type No. of
studies Events/
/participants Events Heterogeneity
between trials P-value for differences across groups Lidocaine
group Amiodarone
group OR 95% CI P-value I2 statistic Full cohort data
ROSC 2 307/430
(71.4%) 140/237
(59.1%) 1.96 1.39–2.77 0.45 0% < 0.001 Survival to 24 h 2 232/430
(54.0%) 94/237
(39.7%) 1.94 1.39–2.69 0.82 0% < 0.001
SHD 2 138/429
(32.2%) 55/235
(23.4%) 1.68 1.16–2.44 0.99 0% 0.006 SHD with favorable
neurological outcome 1 39/186
(21.0%) 30/141
(21.3%) 0.98 0.57–1.68 NA NA 0.95
Matched cohort data
ROSC 2 203/303
(67.0%) 107/179
(59.8%) 1.51 0.64–3.55 0.04 76% 0.35 Survival to 24 h 2 145/303
(47.9%) 71/179
(39.7%) 1.48 0.77–2.83 0.10 64% 0.24
SHD 2 82/302
(27.2%) 43/179
(24.0%) 1.31 0.84–2.05 0.27 16% 0.23 SHD with favorable
neurological outcome 1 12/78
(15.4%) 20/85
(23.5%) 0.59 0.27–1.31 NA NA 0.19
CI — confidence interval; NA — not applicable, OR — odds ratio; ROSC — return of spontaneous circulation; SHD — survival to hospital dis- charge
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Jaroslaw Meyer-Szary et al., Lidocaine vs. amiodarone in pediatric cardiac arrest
